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M
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CASE
HISTORY
NAUSEA
Miss R. is a 63 year-old retired schoolteacher with metastatic breast cancer. She has been on MST 30 mg bd for the past six months with good pain control. Over the past week she has experienced increasing nausea and loss of appetite. She was given oral prochlorperazine but, despite this, her nausea has worsened and she is vomiting once a day. She has a tendency to constipation and is well known to the district nurse who has had to administer suppositories frequently in the past. She has requested the nurse to visit because she has been constipated for four days.
Question 1.
You are the district nurse visiting Miss R. How would you handle this situation?
The nurse notices that the nausea pre-dates the constipation and informs Miss R's GP of her current condition.
Question 2.
What action should the general practitioner take?
Question 3.
What are the possible causes?
You suspect that the cause is liver metastases but send off a blood sample to exclude a metabolic cause.
Question 4.
What measures would you take in the meantime?
The following day the nausea has settled. Her blood tests reveal no underlying metabolic cause.
Question 5.
What would you do next?
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